“It’s a lot of money, but education’s expensive,” said “No On 2” spokesman Dale Butland.
And what did Big Pharma wish to teach Ohioans? In essence: If we can only charge Medicare and Medicaid what we are required to charge the Department of Veteran Affairs, then we will have no choice but to raise our prices for all other insurance providers.
So the case made to Ohioans — at great and disproportional cost — was that if we stood up to the bullies, they would take even more of our lunch money. It’s a good bet that, having let ourselves be bullied again, they will take more of our money anyway.
Ohio has a rare opportunity to lower drug prices this November.
I’m voting Yes on Issue 2, even after seeing all the “No” ads that the drug companies run warning of dire consequences if we dare to demand that we should pay the same for drugs that the Veterans Administration pays.
TV commercial after TV commercial scaring us of excessive legal bills. As if, if the bill passes, the state of Ohio could be bought by PhRMA, since if the law does pass, PhRMA will surely be waging war. As if the voters who passed the law should have no rights in the legal defense of the law. Implying that the state of Ohio will just buckle-in to the big bully’s demands, and the citizens of Ohio dare not have a say-so.
As if drug companies can hold our health hostage and demand outrageous ransoms. As if big PhRMA and big pharma can get away with paying off all of our patient advocacy groups like NAMI, that gets 75% of its funding from pharmaceutical companies, and all of Washington DC. As if pharmaceutical companies can charge ten times more for drugs in the United States than Europeans pay, and Americans aren’t allowed to negotiate. If that is truly so, then only the richest people will ultimately be able to pay, and the rest of us will be out of luck. We aren’t really going let that happen, are we?
Regardless of all that pressure from drug companies and deceptive TV ads that bleed money – confusing ads that indoctrinate us to hate and fill our hearts with prejudice, dread and fear, keeping us down like spineless little mice – an industry that pollutes our communities with their opioids and got Congress to pass a law to ease up on the DEA investigations of how they do it — I’m still voting yes, because voting yes is the only way to get them to stop killing us.
With money to burn, drug companies dominate our nightly dinnertime news hour with ads for very expensive drugs that hardly anyone needs and few can afford. As if we don’t have doctors. Since when do drug companies prescribe the drugs?
Having to pay multiple times the price people pay in Europe for the same prescription drugs is a shameful social travesty and a betrayal of public trust. Yet we’ve been standing aside while they make huge profits and waste our healthcare dollars.
I’m voting Yes on Issue 2, to start the revolution. Taxpayers can save an estimated $400 million per year on state-bought drugs alone. The state of Ohio is a huge pharmaceutical buyer and we deserve the same lower price that the Veterans Administration pays.
If Issue 2 wins, then other states will follow suit, insurers will demand the same price, and we will be shaving billions of dollars off of the unsustainably high cost of healthcare in this country today.
But what I look forward to most of all, is the drying up of the huge pharmaceutical lobby pool, when they don’t have so much money to splash around.
Wouldn’t it be great if We The People could get our elected representatives back?
New for 2018, Marketplace rates for children will rise 20% to 53%, on top of the additional average 20%-30% rate increase insurers in Ohio demand in 2018.
Child rates in the past they have always been 63.5% of the adult base rate until the age of 21. Next year, 0-14 will be 76.5% of the adult base rate, with ages 15 to 20 being 83.3% to 97% of the adult base rate.
2018. We all know how it’s going. We are supposed to feel lucky that we can at least still buy health insurance. And after what we witnessed in Congress this year, and how it could have gone, but for one vote, we know we’re damn lucky.
We were warned that rates would go through the roof this year. That’s due to the uncertainty of the government reimbursing insurers for CSRs, the uncertainty over the insurance requirement mandate, the uncertainty of a repeal, as well as the totally understandable (not), predictable, ever-rising, unsustainable, runaway medical and non-negotiable pharmaceutical cost factors, that alone amount to a 7% rate increase in 2018, along with the resumption of the ACA tax on premiums that was halted last year, and some increases in administration costs. We are braced for rates to going up 20 to 40% or more. Hands above our heads, they got us, we’ll pay!
The ACA, warts and all, has survived the Congressional guillotine, and the 6% of the U.S. population that comprises the individual insurance market is certainly grateful for another year of being able to buy health insurance.
But what a sneaky thing the child age rating hike is, which raises the rates for all children under the age of 21 by 20% to 53%. CMS snuck that in on December 16, 2016, just after Trump was elected. That, on top of all the “uncertainty,” the rising medical costs blah blah blah, 2018 is going to be a real doozy.
Which is why a typical family may see a rate hike of 29% for themselves, and 71% for their children.
Take your typical Ohio family – say, John and Pam, who are 55. They have two kids who are 17 and 20. John is an independent contractor and earns $78,000. Pam is an adjunct university professor and earns $21,000. Together they make $99,000 before taxes, just over the 400% Federal Poverty Level that would qualify them for a health insurance subsidy. Their net income after taxes is $78,000.
Toledo, Ohio is a closed town when it comes to doctors accepting new patients. When it became too costly in 2016, John and Pam had to give up their Medical Mutual PPO insurance and hence their ProMedica doctors that they had been going to for 20 years. Molina was one of the cheapest insurance plans they could buy. But they had to find new doctors, because their long-time doctors didn’t accept Molina insurance.
Mercy doctors were in the Molina network, and they were not as closed as ProMedica doctors. That’s why they chose Molina over CareSource, another cheap plan, but one with a 90% inaccurate provider network, a network that supposedly included ProMedica doctors, but not really. (ProMedica, when last checked, had only one primary care family practice doctor accepting new patients, but you’d have to call back in a month to schedule an appointment, which supposedly would be scheduled for three months after that.*)
If they had made just two thousand dollars less (see Kaiser subsidy calculator here), John and Pam would have qualified for a $3,334 subsidy this year (undoubtably it would be more than $6,000 in 2018 because the SLCSP which is tied to the subsidy may be 20-30% more, in tandem with the rest of the plans; see rate increases below.) The subsidy would have reduced their health insurance premiums to 10% of their gross income for a silver plan, but alas, they make too much money to qualify.
John and Pam chose a gold plan with a lower deductible because they couldn’t afford the risk, just in case, of having to come up with $7,500+ to meet the deductible before the insurance would kick in.
As it was, in 2016 John and Pam paid 22% of their net income on health insurance, $17,448, at $1,454/month. It was a lot more than they were paying just a few years before. An affordable and reasonable percentage, in keeping with the spirit of the ACA, would be 13% of their take-home, or 10% of their gross. John and Pam make more money than most families in Toledo, but to have 22% of their net income going to pay for health insurance really hurts.
In 2016, John and Pam’s rates were $554.50 each per month, and the kids’ rates were $172.62 each.
But next year, in 2018, John and Pam’s health insurance will go up 39%! It will surpass housing as biggest chunk of their budget, becoming a whopping 31% of their take-home income, $24,240 for the year; $2,040/month. The astronomical but necessary expense squeezes out any money that could ever have been saved for retirement, which they need to fund, and eliminates any possible budget they may have hoped for to help their kids with higher education expenses.
click to see 2016 and 2018 Molina rates
WhileJohn and Pam’s health insurance is going up 29%, health insurance for their kids goes up 71%. The family’s health insurance premiums next year will cost $6,792 more than last year!
In the midst of uncertainty and rising medical and unnegotiable pharmaceutical cost factors, what a sneaky rate hike this children’s age rating hike is, and what a scary thing it is for families like John and Pam’s. Thanks, elected officials, for looking out for our best interests. Maybe it’s time to stop the killing and let everyone in on Medicare, expanded and improved.
Anthem is the only insurer right now in 19 Ohio counties, and in 2018 they will be exiting the Ohio individual market, except for one teeny tiny county, Pike, for a non-exchange plan that probably has 5 members, just so they can keep their foot in the door and not be banned for five years in case they want to come back. Awe.
Anthem has about 18% of the individual market in Ohio, and they insure millions of Ohio corporate and state workers. 40,000 individuals are presently covered by Anthem, and 10,000 people may not be offered any individual plan next year as a result.
In Toledo, Anthem has the worst, smallest provider network, and it was 66% inaccurate. It is highly expensive, and went up quite a bit last year.
Anthem more than tripled their premiums in seven years, just like Medical Mutual did, who left hanging an estimated 100,000 people covered by their PPO plans, completely exiting and extinguishing the sale of PPO’s in the individual market, thus eliminating the only national network plan sold to individuals in Ohio. Last year two insurers covered nearly 50% of the Ohio individual market, and now they are gone.
Also gone this year is United Healthcare and Aetna, so just like that, our four largest insurers of the individual market are gone from the individual market, and Ohio let them, even rewarding the insurers with our state employee insurance business. Ohio either has no business sense, or our state really doesn’t care whether or not 300,000 Ohioans can buy insurance in the individual market.
Four things that Ohio can do to mitigate this healthcare crisis:
Ohio should do what New York is doing this year, and ban insurers who leave the exchange from any future participation in public programs such as Medicaid.
Ohio should propose a Medicaid buy-in for anyone in the state, like the plan that Nevada’s legislature just passed for it’s citizens. After all, our commercial insurers in the individual market (Anthem, Medical Mutual, United Healthcare, Aetna) have been replaced by Medicaid insurers (Buckeye Ambetter, CareSource, Molina), and since all of Ohio is covered for Medicaid, it makes sense that these insurers can also cover all of Ohio for the individual market, and with great ease.
Ohio should pass an emergency “any willing provider” law so that citizens can take their insurance dollars to any provider willing to accept them and the payment. At an average of 80% inaccuracies in our provider networks, have the worst that have been reported in the entire country! It’s only civilized that Ohio gives us an”any willing provider” law.
Oscar Insurance Corporation of Ohio, a new insurer for Ohio this year, should cover all the counties that Anthem has left hanging.
But they won’t be covering even one of them. It comes to Ohio to set up shop with Cleveland Clinic in the five counties around Cleveland.
It’s a perfect example to show why market-driven health insurance does not jive with societal needs, and it never will.
(Dream on, hoping for a private, for-profit insurance industry to voluntarily go into 19 counties for the business of a mere 10,000 people who won’t otherwise have insurance, when the company can get the same business by simply marketing to the east side of Cleveland. But for some reason, the for-profit, so called “free market” health insurance model persists. And it has nothing to do with what is best for our country.)
Here’s something the federal government can do: Open up the D.C. Exchange to people without an option, as per U.S. Senator Claire McCaskill’s proposal.
The D.C. Exchange sells insurance for everyone in the country, that is, everyone who is a member of Congress or their staff. I have researched the plans and found that they are really inexpensive compared to what is sold in Ohio. Moreover, it’s quality PPO insurance with national provider networks.
At one time, the ACA was going to have just one exchange for the entire country, like this exchange in D.C. But then the insurers got their mitts on the shaping of the ACA. They sliced it up into hundreds of different state and county plans. Four short years later, insurers are leaving, and hundreds of counties will have no insurance option. It seems logical to open up the D.C. exchange, for everyone. What would be wrong with doing that?
On a final note, the chart below shows the three largest insurers in Ohio, from a report made to the state of Ohio by the actuarial company, Milliman, in 2011. I added to the original chart in light blue, to show the individual rate increases since 2010. (The dark blue along with the red and green show the 2010 rates.)
With the withdrawal of Anthem, none will be in the individual market next year! Our three biggest insurers in the individual market in 2010, gone!
It’s no wonder, because our regulators let their rates go up over 300% in 7 years, while the rates for the group plans went up only a total of 30%. Wow. You’d think that all the new members of these plans had leprosy. I hope they are cured, at least.
Divide, divide, divide. Divide and subtract some more! The huge free market health insurance system is so close to knocking off those 23 million people who just don’t fit in their money-making calculations.
This is my great great grandfather’s photo of the Kickapoo Indian Medicine Company.
The Kickapoo Indian Medicine Company, of New Haven, Connecticut, sold “patent medicine” before they had patents for medicine. They sold snake oil when it was the cure-all. They weren’t really Indian. Kickapoo Medicine was often laced with alcohol, morphine, opium, or cocaine.
The good news is, I finally received some of the provider network consumer complaints that I asked for from the Ohio Department of Insurance.
The bad news is, for many of the complaints, we don’t get to know the outcome because the Ohio Department of Insurance kicks the complaint over to another department, and they make it confidential. The following are paragraphs from the Ohio insurance department’s closing letters for various provider network complaints:
Due to this error we are referring our findings to another division within the Department for further review. Please be aware that investigations by this division and the records pertaining to these investigations are confidential by law. Consequently, the Department will not be able to provide you with any information as to whether an active case investigation will be opened on the matter or if an active case investigation is opened and the status of the investigation.
Based upon our review of the facts and circumstances presented, we determined that CareSource provided you inaccurate information regarding their provider network. The Department is also concerned about the likelihood that additional members have received inaccurate network information as well. Therefore, this matter has been referred to another division in our agency for investigation.
Due to incorrect information provided to you by Buckeye, we have forwarded our findings to another division within the Department for further review. Please be aware that investigations by this division are confidential by law. Consequently, the Department will not be able to provide you with any information as to whether an active case investigation will be open on the matter you reported or if an active case investigation is opened and the status of the investigation.
Caresource did not initially administer the claim in accordance with the terms of your policy; therefore, we have forwarded our findings to another division within our Department for further review. Please be aware that investigations by this division and the records pertaining to these investigations are confidential by law. Consequently, the Department will not be able to provide you with any information as to whether an active case investigation will be opened on the matter you reported or if an active case investigation is opened and the status of any investigation.
We have forwarded our findings to another division within our Department for further review. Please be aware that investigations by this division are confidential by law. Consequently, the Department will not be able to provide you with any information as to whether an active case investigation will be opened on the matter you reported, or the status if an investigation is opened.
What is the law that they claim prevents them from revealing the status or results of the investigation? The new provider network rules they put into place this year. They wrote in a clause that gives them the power to keep investigations confidential.
(2) All documents provided to the superintendent under paragraph (G) of this rule shall be considered work papers of the superintendent that are subject to section 3901.48 of the Revised Code and are confidential and privileged and shall not be considered a public record, as defined in section 149.43 of the Revised Code. The original documents and any copies of them shall not be subject to subpoena and shall not be made public by the superintendent or any other person, except as otherwise provided in section 3901.48 of the Revised Code.
Clever! So all of our provider network complaints get buried. Companies get to keep doing this, because the Ohio Department of Insurance doesn’t care. They reward them instead, with confidentiality. And after two years, they destroy the original complaint, buried, burned, deleted.
Last summer, a woman in Dayton, Ohio made a complaint to the Ohio Attorney General that she and her husband bought a Molina Marketplace plan because their doctors were listed on it, but when they tried to schedule appointments, the doctors didn’t actually take Molina. Molina had in fact issued her a card with those doctors names on it. She asked the Molina call center to help her find a doctor, and the customer service representative called all the doctors in her area, and couldn’t find her one doctor in the Molina network. She faced having to pay for this insurance for an entire year – $10,034 for absolutely nothing!
“They baited us into choosing this insurance plan by listing doctors who do not accept their marketplace insurance product and we are now stuck until the next open enrollment period.”
Bait with doctors and switch to nothing.
Here is how Molina’s advertised provider network of primary care doctors stacks up to other Marketplace provider networks in Toledo, downloaded on July 16, 2016. 13 out of 57 doctors on Molina’s Internal Medicine list are listed a total of 25 more times on the list with one doctor listed 7 times. The duplications nearly double the apparent size of the network, which shows 57 internal medicine primary care doctors.
Only one of the seven Toledo Clinic doctors on the Molina provider list actually accepts Molina insurance.
But only thanks to the Mercy Health providers, Molina actually has the most primary care doctors available to accept new patients. See, my Ohio Citizen Rate Review Provider Network Survey, Summer 2016. Molina has a mere 77% rate of inaccuracies; 59% inaccurate if you subtract all the duplications. Although that’s nothing to brag about, it was refreshing to hear that many yeses in a sea of so many no’s.
Molina currently has 10,878 members, and their projected membership for 2017 is 19,083. The Toledo area has 556 members in 2016, up from 383 in 2015. Molina projects next year’s Toledo membership to nearly double, expecting a 10%+ market share of the area healthcare.gov sales.
Molina covers 325,000 Ohioans in Medicaid and Medicare plans. They serve 3.5 million members in 11 states and Puerto Rico. The Molina CEO’s compensation was 11.9 million in 2013.
Molina anticipates a 5.9% increase in unit cost (4.8%) and utilization (1.1%). Molina calculated a medical loss ratio (MLR) for 2017 of 88.1%, itemizing about 2% on “quality improving activities” and about 78% on incurred claims. Molina expects their new members to be healthier, with nearly the same age mix as in 2016.
Molina expects prescription drugs to cost 6% more next year, with a 2.5% increase in the use of the drugs.
A Wakely Consulting Risk Survey that Molina participated in estimated a risk transfer receivable of $67.03.
Molina is asking for an aggregate .9% decrease in rates next year. The range of the rate change will be from -6.1% to +9.7%.
Look out, Ambetter by Centene! Molina’s coming after you for the SLCSP benchmark plan. I wonder, does the government give a bonus to Centene (and Ambetter) or Molina for reducing their rates (which lowers the tax credit / subsidy the government pays) as a backdrop for the other insurance offerings to raise their rates by double-digits, rates so high, they become more than half the median household income? Is this in the grand master plan, to get everyone out of “real” insurance? Do the provider network inaccuracies matter little, in the government’s scheme of things? We may be lucky in Toledo, but think of the woman in Dayton last year.
Molina is a giant managed care organization for Medicaid and Medicare, making megabucks from the U. S. government, like Centene’s Ambetter. Both are now competing for the Marketplace market. According to my provider network survey, Molina has the most potential for integrity. If only Molina could do a little bit better.
In 2014, CareSource charged too much for their premiums, and had to send rebate checks in 2015. However, according to complaints made to the Ohio Attorney General’s office, the checks were worthless because they had an incorrect routing number on them.
There are many complaints about members being unable to find doctors. Here is mine, that I first made to CareSource, and then made to the Ohio Department of Insurance:
Three weeks into the 2015 Open Enrollment, I called the offices of 50 ProMedica primary care physicians who were listed on the CareSource Just4Me network of Lucas County PCPs as accepting new patients, marked with a definitive YES. CareSource is one of the two, maybe three, affordable plans on healthcare.gov. CareSource also administers Medicaid plans. Only two out of 50 ProMedica PCPs on their network listed as YES actually were accepting new patients. I called CareSource. I spoke to a customer service representative and to the press relations department. I was actually impressed with their responsiveness — the concern they expressed and the actions they said they were going to take, and I thought maybe CareSource might be okay, after all. From their reactions — how sorry they were, how they took all the details, how the head of the public relations/press relations department called me back the next day with another person on the line, saying that they were going to fix this, that they were going to get someone up here immediately to talk to ProMedica, and that CareSource would be correcting their listings – I thought, this is a refreshing change from what I’m used to encountering with health insurance. But it’s been a week, and there are only two weeks left for Open Enrollment, and misrepresentation like that isn’t corrected immediately when the buyers of health insurance are under such a deadline is just not acceptable.
And guess what, the doctors are still listed as accepting new patients nine months later; only one has been corrected. I called the entire list of internal medicine and family practice primary care physicians this summer for my Ohio Citizen Rate Review Provider Network Survey. CareSource listed 166 doctors accepting new patients, when, according to the doctors themselves, only 17 are accepting new patients, and CareSource has 51 duplications of names on their list.
CareSource doesn’t care. Why haven’t they fixed this? 90% is inaccurate, for gosh sakes!
My November complaint to CareSource and my April complaint to the Ohio Department of Insurance hasn’t changed a thing! It’s not hard to make corrections, so it must be something else that keeps CareSource from telling the truth about these doctors’ panel statuses. False advertising! Is it the CMS audit?
The Ohio Department of Insurance may or may not correct it, and we will never know if they are investigating it or not, because they made that little rule for themselves. How convenient.
These matters have NOT been properly addressed.
No corrections to their provider network database after all this time, and why is that?
Two sets of books, as the saying goes?
Whatever it takes to get their CMS rating, and the heck with the patients?
Patients don’t get invited to the party?
Is this not fraud on a very high level?
There can be no excuse for not correcting this immediately, let alone allowing it sit like that for 10 months!
CareSource 2017 Rate Review
CareSource is asking for a 13.53% increase — that’s the average increase from last year — the actual increases vary, estimated by me to be between 5% and 30%. The 30% if you are unlucky enough to be in your fifties or sixties. You don’t get to check the math, because they crossed out all the numbers (not that they are allowed to)…..
Below are screenshots of CareSource’s 2016 Actuarial Memorandum for their Marketplace plans – with all the details redacted, so we don’t get to know!
And who am I supposed to ask? You have no contact info on your website!